| NPI | 1639393614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301007927) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301007927) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301007927) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301007927) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301007927) | |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301007927) | |
| 103G00000X Clinical Neuropsychologist (Licence: MI 6301007927) | |
| 103T00000X Psychologist (Licence: MI 6301007927) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MI 6301007927) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2017-10-11 |